Endovascular management of iatrogenic cervical internal carotid artery pseudoaneurysm in a 9-year-old child: Case report and literature review

Pinzón, Martín; Lobelo, Nelson; Rodríguez, María Claudia; Villamor, Perla; Otoya, Ana María

doi:10.1016/j.ijporl.2017.01.031

Cited by 11 publications

(7 citation statements)

References 36 publications

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“…There are a few reports on the treatment of pseudoaneurysms in children using covered stents. 8 These show good initial results, but long term results have not been reported. 9 The immediate complications of stenting are thrombosis, micro-embolisation, and carotid artery dissection.…”

Section: Discussionmentioning

confidence: 86%

Covered Stent Treatment of an Extracranial Internal Carotid Artery Pseudoaneurysm in a Three Year Old Child with 12 Years of Follow Up: A Case Report

Sánchez

Pérez

Einersen

2021

EJVES Vascular Forum

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Introduction Extracranial internal carotid artery (ICA) pseudoaneurysms in children, although uncommon, are life threatening. Covered stents are a good alternative treatment, as they avoid the risk of open surgery and preserve the ICA. Until recently, long term outcomes were unknown. Report A three year old boy was hospitalised with an enlarged swelling on the left side of his neck and severe respiratory distress. He had been treated a month prior for a left deep cervical abscess, with bacteriological culture positive for Staphylococcus aureus . Computed tomography angiography (CTA) revealed a large pseudoaneurysm originating from the left ICA, approximately 2 cm above the bifurcation. A balloon expanded covered stent (Jostent Graftmaster; Abbott Vascular, Redwood City, CA, USA) was deployed via a left femoral approach, after selective angiography, to seal the carotid rupture without incident. Control angiography revealed immediate exclusion of the pseudoaneurysm and patent ICA. The bacteriological culture of the residual haematoma was negative. The child was discharged with full recovery and without neurological sequelae, under platelet anti-aggregation. He has been followed up and has remained asymptomatic for 12 years, with CTA confirmed ICA patency, without deformation or evidence of significant restenosis. Discussion This is the first report of the long term outcome of a covered stent in a child treated at three years of age, with a 12 year follow up. The good performance of the covered stent in this case reinforces its adoption as a first line option in the treatment of extracranial ICA pseudoaneurysms in children.

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Section: Discussionmentioning

confidence: 86%

Covered Stent Treatment of an Extracranial Internal Carotid Artery Pseudoaneurysm in a Three Year Old Child with 12 Years of Follow Up: A Case Report

Sánchez

Pérez

Einersen

2021

EJVES Vascular Forum

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“…While the risk of stroke is a concern associated with surgical ligation, it appears that the incidence of stroke in neonates is relatively lower compared to older patients. [10][11][12][13] Our study is subject to several limitations, including its retrospective, single-center design, and a relatively small sample size.…”

Section: Discussionmentioning

confidence: 99%

“…In rare instances, particularly when dealing with complex pseudoaneurysms or a lack of expertise in endovascular procedures, surgical ligation of the affected vessel may be deemed necessary. While the risk of stroke is a concern associated with surgical ligation, it appears that the incidence of stroke in neonates is relatively lower compared to older patients 10–13 …”

Section: Discussionmentioning

confidence: 99%

Incidence, risk factors, and management following cardiac catheterization via carotid and axillary artery approaches: A single‐center experience on pseudoaneurysms in young infants

Takajo,

Newkirk,

Shahanavaz

2024

Cathet Cardio Intervent

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BackgroundUse of alternate access for complex neonatal interventions has gained acceptance with carotid and axillary artery access being used for ductal and aortic interventions.MethodsThis study was a retrospective, single‐center study at Cincinnati Children's Hospital Medical Center. The study included infants, aged ≤90 days, who underwent cardiac catheterization with either carotid or axillary artery access between 2013 and 2022. Data encompassing demographics, clinical information, catheterization data, and the incidence of pseudoaneurysm as a procedural complication were collected.ResultsAmong 29 young infants (20 males, 69%), 4 out of 15 patients (27%) who underwent the carotid approach developed pseudoaneurysms, while 1 out of 14 patients (7.1%) who underwent the axillary approach developed one. Two patients required transcatheter intervention due to enlargement of pseudoaneurysms, involving the placement of transarterial flow‐diverting stent and occlusion of left common carotid artery. Longer sheath in‐to‐out time (135 vs. 77 min, p = 0.001), and higher closing activated clotting times (ACT) (268 vs. 197 s, p = 0.021) were observed among patients with pseudoaneurysms compared to those without.ConclusionsYoung infants with alternative access via the carotid and axillary arteries may be at risk of pseudoaneurysm formation during longer procedures and with higher ACTs for closure. Ultrasound‐guided compression can be employed to prevent the progression and in resolution of these lesions.

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“…Iatrogenic extracranial carotid pseudoaneurysms treated with endovascular stenting have exhibited good outcomes in the adult populations, resulting in aneurysm occlusion and preservation of the artery without significant complications. 19 We decided to treat the carotid pseudoaneurysms endovascularly with a stent given its safe and high technical success rate at large academic institutions. 20 To prevent associated thrombosis, embolism, or vessel dissection, our patient was placed on dual antiplatelet therapy after successful endovascular intervention.…”

Section: Discussionmentioning

confidence: 99%

Large prevertebral hematoma and carotid pseudoaneurysm following percutaneous anterior cervical discectomy: illustrative case

Basil

Sprau

Starke

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDThe percutaneous, endoscope-assisted anterior cervical discectomy is a relatively new procedure, and because of its novelty, complications are minimal and pertinent literature is scarce. This approach relies on a sufficient anatomical understanding of the vital neurovascular structures in the operating workspace. Although complications are rare, they can be significant.OBSERVATIONSThe patient presented with difficulty breathing following an anterior percutaneous cervical discectomy performed at an outpatient surgical center. Imaging revealed a prevertebral hematoma and multiple carotid pseudoaneurysms. Given the large prevertebral hematoma and concern for imminent airway collapse, the authors proceeded with emergent intubation and surgical evacuation of the clot.LESSONSThe authors propose managing complications in a fashion similar to those for comparable injuries after classic anterior approaches. Definitive management of our patient’s carotid injury would require stenting and, therefore, dual antiplatelet agents. Thus, the authors proceeded with the hematoma evacuation first. Additionally, careful dissection was needed to decrease further carotid damage. Thus, the authors made a more rostral incision to maintain the given stability of the carotid insult before the angiographic intervention to follow. It is the authors’ hope that the technical pearls from this two-staged open hematoma evacuation and endovascular stenting may guide future presurgical and intraoperative planning and management of complications, should they arise.

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Endovascular management of iatrogenic cervical internal carotid artery pseudoaneurysm in a 9-year-old child: Case report and literature review

Cited by 11 publications

References 36 publications

Covered Stent Treatment of an Extracranial Internal Carotid Artery Pseudoaneurysm in a Three Year Old Child with 12 Years of Follow Up: A Case Report

Covered Stent Treatment of an Extracranial Internal Carotid Artery Pseudoaneurysm in a Three Year Old Child with 12 Years of Follow Up: A Case Report

Incidence, risk factors, and management following cardiac catheterization via carotid and axillary artery approaches: A single‐center experience on pseudoaneurysms in young infants

Large prevertebral hematoma and carotid pseudoaneurysm following percutaneous anterior cervical discectomy: illustrative case

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